dull - Is your horse generally lackluster and seemingly without energy?
A Case In Point
Learn how an ulcer affected Olympic dressage team alternate Kathleen Raine's horse, Fidelia.
It was a combination of signs that caused Richard Markel, DVM, to suspect ulcers when Fidelia, the horse ridden by Olympic dressage team alternate Kathleen Raine, wasn't performing up to par. In 1999, after winning the reserve championship at the Festival of Champions at the U.S. Equestrian Team headquarters in Gladstone, New Jersey, Fidelia (affectionately known as Fiddle) and Raine journeyed to Europe.
"It had been really hot in New Jersey, and the heat had affected Fiddle," recalls Raine. "But the top five horses went on to Holland, so she endured about a 30-hour trip to England, and when she arrived there, she was treated for mild colic." Fidelia's colic returned and was treated two more times, and finally Raine placed a call to her veterinarian back in the United States.
Guessing at ulcers but unable to verify his diagnosis through an endoscopic examination, Markel arrived with a full course of medication. Within days, Fidelia improved, and she suffered no other bouts of colic while in Europe. However, once she arrived back in the United States, she started showing signs of being "off." Again, Raine was concerned because Fidelia has always been known for giving her all at every opportunity, whenever asked.
"Fidelia is just as sweet a horse as you could find, and she became a grouch," says Markell. "It was just so uncharacteristic of her. So we scoped her and saw healed lesions and some starting to recur. We immediately treated her again, and she is back to being a big pet."
The Key to Diagnosis
"The only way to tell if your horse has ulcers is to have him checked by a veterinarian with a three-meter endoscope that can get into the horse's stomach," says Murray. In this way the veterinarian can detect whether a horse does, indeed, have ulcers. He also can see how severe they are.
Prior to submitting to an endoscopic examination for ulcers, a horse will have his food withheld for about 12 hours, and he won't be allowed to drink water for about six hours before the exam. Then the veterinarian will insert the flexible endoscope through the horse's esophagus and into his stomach, where the veterinarian will view any ulcers.
"The treatment of ulcers is important because it is essential to use a treatment that will really work," Murray says. "The best, and most useful treatment at the moment of EGUS is omeprazole, which is available under the brand name of Gastrogard for horses." (For people, omeprazole is available under the trade name Prilosec.)
Within the body, omeprazole works by shutting down some of the stomach cells' ability to produce large quantities of hydrochloric acid, thus giving an equine ulcer time to heal. In contrast, oral antacids like Maalox and Mylanta work to neutralize stomach acid that already has been produced.
A third type of medication, known as an H2 blocker, competes with the compound histamine, which is naturally secreted by body tissues, so that it cannot stimulate stomach cells to produce acid. H2 blockers include cimetidine (Tagamet), ranitidine (Zantac) and famotidine (Pepcid AC).
Murray chooses to use omeprazole for three reasons: First, it is the only treatment for EGUS currently approved by the Food and Drug Administration (FDA). Secondly, the drug shuts down acid secretion by knocking out the acid pumps, as opposed to competing with the stimulant. Third, omeprazole is easiest to administer than other drugs. A paste that comes in a tube, omeprazole is given once a day.
The Cost of Treatment
Treating a horse the size of a warmblood costs about $40 to $60 a day, and a full course of the medication runs 28 days. Despite the higher cost - a total $1,120 to $1,680 - Murray says, "Most of our clients want to use omeprazole because the horse can stay in training, he heals quicker and is better sooner. Also, the product is convenient to use."
In contrast, generic H2 blockers cost about $15 a day. They are given in large doses every six to eight hours, depending on the individual case.
In the past, one of the problems commonly experienced with H2 blockers was that many horses were being under-dosed. As a result, the medication was not effectively decreasing stomach acidity. In some cases, it was of no use at all.
"This is where the owner-placebo effect comes into play," says Murray. In other words, the owner wanted the product to work, and so he or she felt that the product had worked.
Protecting Horses From Ulcers
Luckily, thre are ways to prevent horses from developing ulcers. Management is key. Murray suggests turning out horses as much as possible so they can graze. He also cautions against feeding too much grain, which not only can cause colic, but also sets the stage for ulcers since it increases the production of gastrin, the hormone that stimulates acid secretion. "Just like the kid who eats too many candy bars, the horse that eats too much grain will not be interested in his veggies," Murray says. In other words, he'll spend less time eating the hay or grass that's beneficial to his digestive system.
Is there a diet horse owners can use to prevent equine ulcers?
"Diets in relation to ulcers are under a lot of investigation," Murray replies.
"We don't know that such a diet exists or if it is compatible with the rest of the digestive system of the horse. It might be years before we know the answers to these questions," he says.
Nevertheless, if your horse is traveling a great deal to perform in a number of competitions and he's likely to be subjected to stressful conditions, it might be worth considering medical intervention to keep him from developing ulcers. When used as a preventative, omeprazole is administered in half the normal treatment dose. It's a tactic that is being adopted by some upper-level riders and trainers. For example, after undergoing colic surgery in Florida, Grandeur, the horse ridden by Steffan Peters, received omeprazole as a preventative. "We never had him scoped," says Allyson Rogers, Peters' assistant, "but it just made sense after the colilc to offer it during stressful situations such as travel."
Some horses handle a change in routine perfectly well and show no signs of stress or discomfort, and others react in a range of ways with various levels of discomfort. Unfortunately, there are no blood tests to reveal whether a horse has ulcers or to what extent. If ulcers are diagnosed and medication prescribed, a horse usually improves within two to three days. Most of the time horses with EGUS are treated on an outpatient basis.
The big question, of course, is exactly what do horses with EGUS experience.
"We have to rely on our observation of symptoms," says Murray, since there is no way to really know what sort of pain a horse with ulcers experiences. Fortunately, advances in medicine combined with new insights into the management of horses are offering relief for what ails the equine stomach.
From Dressage Today magazine.